1. Intravenous cannulation

2. What is IV cannulation?
Intravenous cannulation is a technique in which a cannula is placed inside a vein to provide venous access.
Venous access allows:
sampling of blood
administration of IV fluids and medications,

3. Cannula This device is available in various gauges (16-24 G),
lengths (25-44 mm),
compositions, and
designs.

4. Cannula Gauge Size 22 Gauge: 0.8 mm 20 Gauge: 1.0 mm 18 Gauge: 1.2 mm

5. Tips
Routinely, use the smallest size (largest gauge number) of catheter if possible to prevent damage to the vessel intima
In an emergency situation use a large gauge catheter to allow administration of large volumes of fluid quickly

6. Tips
The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access
they interfere less with patient mobility and pose a lower risk for phlebitis.

7. Tips
It is recommended to choose a straight portion of a vein to minimize the chance of hitting valves.
Use the patient’s non-dominant arm (if possible)
For prolonged courses of therapy, it is recommended to start distally and move proximally as distal catheters are replaced.

8. Indication Repeated blood sampling Intravenous administration of
IV fluids
Medications
Chemotherapy
Nutritional support
Blood or blood products administration
Radiological contrast agents for computed tomography, magnetic resonance imaging, or nuclear imaging

9. Contraindications
No absolute contraindications to intravenous cannulation exist
Avoid peripheral venous access in an injured, infected, or burned extremity if possible

10. Equipment Non-sterile gloves Tourniquet Antiseptic wipes 5-ml syringe
Sterile gauze
Cannula
Saline
Adhesive Plaster

11. Before the procedure
Introduce yourself to the patient. Explain the procedure to the patient and gain informed consent to continue
Make sure there is adequate light and that the room is warm enough to encourage vasodilation
Make sure the patient is in a comfortable position and place a pillow or a rolled towel under the patient’s extended arm
The patient’s skin should be washed with soap and water if visibly dirty

12. Before the procedure
If difficulty is encountered in finding an appropriate vein, one of the following techniques may be used:
Inspection of the opposite extremity
Opening and closing the fist
Using gravity (holding the arm down)
Gentle tapping or stroking of the site
Applying heat (warm towel/pack)

13. Technique Apply tourniquet and select the appropriate vein
Apply an antiseptic solution with friction for seconds, allow to air dry for up. Once cleaned, do not touch or re-palpate the skin
Remove the cannula from its packaging and remove the needle cover ensuring not to touch the needle
Stretch the skin distally and tell the patient to expect a sharp scratch

14. Technique Insert the needle, bevel upwards at about 30 degrees
Advance the needle until a flashback of blood is seen in the hub at the back of the cannula
Once this is seen, progress the entire cannula a further 2mm, then fix the needle, advancing the rest of the cannula into the vein

15. Technique Insert the needle, bevel upwards at about 30 degrees
Advance the needle until a flashback of blood is seen in the hub at the back of the cannula
Once this is seen, progress the entire cannula a further 2mm, then fix the needle, advancing the rest of the cannula into the vein

16. Technique
Release the tourniquet, apply pressure to the vein at the tip of the cannula and remove the needle fully
Remove the cap from the needle and put this on the end of the cannula
Carefully dispose of the needle into the sharps box

17. Technique
Check function by flushing with saline. If there is any resistance, if it causes any pain, or you notice any localized tissue swelling; immediately stop flushing, remove the cannula and start again
Apply the plaster to the cannula to fix it in place
Finally, ensure that the patient is comfortable and thank them

18. Complications Pain Failure to access the vein
Blood stops flowing into the flashback chamber
Arterial puncture
Thrombophlebitis
Hypersensitivity reaction
Peripheral nerve palsy
Skin and soft tissue necrosis
When some irritant solutions leak into the tissue e.g. chemotherapeutic agents
More safely infused into a central vein

19. Complications
Thrombophlebitis

20. Complications Thrombophlebitis Hypersensitivity reaction
Peripheral nerve palsy

21. Complications Thrombophlebitis Hypersensitivity reaction
Peripheral nerve palsy
Skin and soft tissue necrosis
When some irritant solutions leak into the tissue e.g. chemotherapeutic agents
More safely infused into a central vein

22. Intravenous fluid

23. Indications Maintain or replace body store Restore acid abase balance
Restore the volume of blood component
Administer of medication
Provide Nutrition
Monitor CVP

24. Equipment
Tray
Sterile syringes
Spirit swabs
Drip stand
Drip + set

25. Technique Introduce yourself to the patient.
Check the patient’s name and the type of fluid to be given
Explain the procedure to the patient and gain informed consent
Prepare your equipment
Assemble the tubing solution according to the manufacturer’s instruction

26. Technique
Let out the air from the tubing by letting some of the fluids run down the tubing
Close the drip set to prevent fluid from flowing out
Hang the bag in the drip stand
Open the cannula and connect it to the drip
Adjust the drips according to the appropriate dose (X drops per minute)
Check regularly to see that the fluid is dripping at the same rate and that fluid is going in to the vein properly and that the puncture site is not swollen.

27. Types Of IV Fluids 1. CRYSTALLOIDS Isotonic
0.9% Sodium Chloride (NS)
Lactated Ringers
Dextrose 5% in Water (D5W)
Hypotonic
0.45% Sodium Chloride
Hypertonic
5% Dextrose in NS
5% Dextrose in Lactated Ringers
5% Dextrose in 0.45% ½ NS
10% Dextrose in water
2. COLLOIDS (plasma expanders)
Albumin
Plasma Protein fraction
Dextran
Hetastarch

28. Blood Transfusion

29. Indications Treatment of anaemia
Treatment of coagulation, platelet disorders
Treatment of hypovolemia

30. Before the procedure
Two people to check details (name, blood group and compatibility)
Blood transfusion report form; Unit(s) of blood
Patient with IV access and wrist ID band
Sterile blood giving set
Prepare adrenaline, antihistamine and hydrocortisone beside the patient
Warm the blood

31. Technique Introduce yourself to the patient
Explain the procedure and indication
Gain verbal consent
Ensure patient has patent venous access by running NS through
Check equipment – Correct unit of blood and blood giving set
With a partner – check patient’s name, blood group and number of units of blood to be given

32. Technique -2 Put on gloves
Attach unit of blood to giving set and run through blood correctly emptying the air in the set
Connect the blood giving set to cannula; Secure the giving set and cannula with bandaging.
Ensure blood is flowing and set at correct rate
Inform nurses blood is running and to make sure routine observations are made.
If any reaction has occurred the nurse should stop the transfusion and call the doctor on call immediately

33. Calculating the rate Drip Rate (drop/min) =
Volume to be infused (ml) x Drop Factor (drp/ml)
Time (minutes)

34. Blood products Whole Blood Packed Cells Platelets
Fresh Frozen Plasma (FFP)
Cryoprecipitate

35. Complications A. Acute complications: Acute intravascular hemolysis
Febrile non-hemolytic reactions
Allergic reaction and anaphylaxis
Septicemia
Transfusion Related Acute Lung Injury (TRALI)
Hypothermia (why? – How to avoid?)
Volume overload

36. Complications B. Delayed complications
Delayed haemolytic transfusion reaction
Transfusion associated Graft versus Host disease
Post Transfusion Purpura
Citrate Intoxication and Hyperkalemia
Infectivity-Hepatitis B & C, HIV, CMV, Syphilis and malaria
Delayed haemolytic transfusion reaction: occurs 1-4 weeks after transfusion
Post Transfusion Purpura: the body produce antibodies to doner platelet’s and caused destruction of doner and recipient platelets
Citrate toxicity: anticoagulant to preserve stored blood, it binds to calcium and magnesium causing serious hypocalcaemia and hypomagnesaemia
Hyperkalemia
Infection: Hepatitis B & C, HIV, CMV, Syphilis and malaria

37. Summary IV cannulation is a very common daily procedure
Used to obtain blood samples, insert IV fluids, medications, nutrients, and blood transfusion and blood products
Could be life-saving
Should be performed following proper procedure to avoid problems and complications